Pathmark Stores Inc

Primary specialty

PharmacyTaxonomy code 333600000X

License

016040 Issued in NY

Legal business name

PATHMARK STORES INC

Doing business as

Pathmark Pharmacy

Practice address

5145 Nesconset Hwy
Port Jefferson Station, NY 11776-2047

Phone

(631) 331-2210

Fax

(631) 473-3291

NPI assigned

Sep 20, 2006

Organization subpart

Yes

Parent organization

GREAT ATLANTIC & PACIFIC TEA CO., INC, THE.As reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Susan D Kijowski

Title

Manager, Regulatory Compliance

Phone

(201) 571-8326

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• PATHMARK PHARMACY Doing business as

Part of

The Great Atlantic Pacific Tea Co Inc

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Great Atlantic & Pacific Tea Company Inc

  dba A & P Pharmacy

  • Pharmacy
  • Fairview, NJ
  • NPI 1518982172

  Member Of

  NPD member

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1376611200000",
    "number": "1962509737",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 416369",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022416369",
            "telephone_number": "201-571-4568",
            "fax_number": "201-571-8335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5145 NESCONSET HWY",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117762047",
            "telephone_number": "631-331-2210",
            "fax_number": "631-473-3291"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PATHMARK STORES INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GREAT ATLANTIC & PACIFIC TEA CO., INC, THE.",
        "enumeration_date": "2006-09-20",
        "last_updated": "2013-08-16",
        "status": "A",
        "authorized_official_last_name": "KIJOWSKI",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "MANAGER, REGULATORY COMPLIANCE",
        "authorized_official_telephone_number": "201-571-8326"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NY",
            "license": "016040",
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NY",
            "license": "016040",
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00490111",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "3364229",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PATHMARK PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Grace Elizabeth Papile
• Sophia Parise
• Joey Labso Pascasio, M.D.
• Nishi Patel, DDS
• Vipul A Patel, PHARM.D.,BCP,CGP
• Patrick J. Sabo, D.M.D. & Mark a. Rienecker, D.D.S., P.C.
• Jennifer Michelle Patrick
• Dreux Patton, M.D.
• Kathleen Paulson
• Lemuel G Payne

• Pharmacy in Port Jefferson Station, NY
• Providers in Port Jefferson Station, NY by specialty
• Pharmacy in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.